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NPI Code Detail

MEDICARE: AMANDA N CROMER NP-C, AOCNP

MEDICARE: AMANDA N CROMER NP-C, AOCNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner900460NC

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12592234OTHERNCMEDICARE PTAN
2259223AOTHERNCMEDICARE PTAN
3259223BOTHERNCMEDICARE PTAN

General Provider Information

NPI Number : 1174590004
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA N CROMER NP-C, AOCNP
Provider Business Mailing Address
First Line : 200 QUEENS RD
Second Line : SUITE 400 SOUTHEAST RADIATION ONCOLOGY GROUP
City : CHARLOTTE
State : NC
Zip : 28204-3264
Country : US
Telephone Number : 704-333-7376
Fax Number : 704-333-3397
Provider Business Practice Location Address
First Line : 1000 BLYTHE BLVD
Second Line : SUITE 3809 CAROLINAS MEDICAL CENTER-RADIATION ONCOLOGY
City : CHARLOTTE
State : NC
Zip : 28203-5812
Country : US
Telephone Number : 704-355-2272
Fax Number : 704-333-3397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 04/05/2013

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